On his first day in office, President Trump made good on his campaign promises by issuing various immigration-related executive orders. In his inauguration speech, the new president defended his actions by declaring: “Illegal entry will immediately be halted, and we will begin the process of returning millions and millions of criminal aliens back to the places from which they came.”

This shift in government policy has healthcare providers concerned that some patients might opt to delay or forgo needed care rather than risk being questioned or apprehended by immigration enforcement authorities. The shift also has providers asking whether or how their policies and practices must change in order to address the reality of more aggressive immigration law enforcement. We’ll attempt to answer some of these questions.

Are healthcare providers legally obligated to treat undocumented immigrants?

In general, healthcare providers have the right to choose whom they will and will not serve. However, Medicare-participating hospitals are required under the Emergency Medical Treatment and Labor Act (“EMTALA”) to provide emergency medical care to all patients, regardless of immigration status. In addition, providers may be obligated by the terms of their government and private payer agreements to render care on a non-discriminatory basis to program beneficiaries, some of whom may be undocumented immigrants. It is worthwhile to note that undocumented immigrants are ineligible for most federal benefits, including Medicaid and the Children’s Health Insurance Program. As a result, an estimated 45% to 71% lack health coverage.

Are healthcare providers legally obligated to report undocumented immigrants to law enforcement?

No, healthcare providers are generally not required to contact law enforcement when they encounter patients who are or may be undocumented immigrants. HIPAA allows a provider to report to law enforcement a “crime on the premises” (emphasis added). But reporting a crime is discretionary, not mandatory. Also, determining one’s immigration status can be complex and not all immigration violations are “crimes.” Therefore, healthcare facilities should provide clear instructions to frontline staff regarding whether and when reporting will be allowed or expected.

Are healthcare providers required to ask about patients’ immigration status?

Except in Texas and Florida, healthcare providers are not required to ask about their patients’ immigration status. In fact, some providers may decide they would be better off not knowing. One reason is to reduce their potential liability under the so-called “Alien Harboring” statute, which can be used to prosecute individuals who allegedly conceal, harbor, or shield undocumented immigrants from detection. The National Immigration Law Center recommends that healthcare providers also refrain from including immigration status in patient medical records, which could be subpoenaed or subject to search warrants and court orders.

Are healthcare providers required to allow U.S. Customs and Border Protection, U.S. Immigration and Customs Enforcement, and other law enforcement officers search their premises for undocumented immigrants?

CBP, ICE, and other law enforcement officials are generally permitted to search public areas of hospitals and other healthcare facilities without a warrant. During the Biden Administration, the Department of Homeland Security implemented a policy of limiting enforcement activity and warrantless searches of “sensitive” or “protected” areas, which include hospitals, doctor’s offices, and health clinics (as well as churches and schools). On January 21, 2025, President Trump rescinded that policy. A supportive DHS spokesperson explained:

[President Trump’s] action empowers the brave men and women in CBP and ICE to enforce our immigration laws and catch criminal aliens—including murders [sic] and rapists—who have illegally come into our country. Criminals will no longer be able to hide in America’s schools and churches to avoid arrest. The Trump Administration will not tie the hands of our brave law enforcement, and instead trusts them to use common sense.

A relevant question under the Fourth Amendment to the U.S. Constitution is whether an individual has a reasonable expectation of privacy in the location or item that is the subject of the search. Accordingly, some healthcare facilities have designated certain rooms as private areas that are available only to patients and their providers. They have also appointed gatekeepers who are responsible for validating the sufficiency of search warrants and court orders presented by law enforcement officers who might attempt to search the premises.

Should healthcare providers establish written policies and procedures that spell out how interactions with undocumented immigrants and immigration law enforcement officials will be handled?

Each healthcare provider must decide for itself whether and how to implement policies and procedures on undocumented immigrant issues. Such a decision may turn on a number of factors, including the number or percentage of patients in the provider’s service area who may be undocumented immigrants, as well as the prevailing attitudes among leaders and staff about immigration-related issues. Healthcare providers that operate in locations governed by state or city “sanctuary laws” should be alerted that the Trump Administration intends to challenge those laws aggressively, as well as the officials who implement them. Providers in those regions may see a significant increase in immigration enforcement activity and should prepare accordingly. Regardless, all providers are encouraged to adopt robust policies on general patient privacy and staff interactions with law enforcement.

This article summarizes aspects of the law. This article does not constitute legal advice. For legal advice regarding your situation, you should contact an attorney.